Before I even started high school, I knew I wanted to become a physician. However, after my freshman year of college, I questioned whether I would make that dream come true. I was struggling to maintain my STEM GPA, and I believed I just was not cut out for medicine. I was ready to give up, but then I participated in the Biomedical Research Internship for Minority Students (BRIMS) at Cincinnati Children’s Hospital. This program gave me the courage and confidence to continue pursuing medicine. I was able to network with highly successful minority physicians, learn new study techniques, and most importantly, I gained a new outlook.
During the BRIMS program, I discussed the struggles I faced with science courses my freshman year. Through workshops with my colleagues and mentors, I realized that my public-school College Preparatory Chemistry course during 10th grade might have left me with less of a foundation than some of my classmates. This by no means meant I was not as intelligent or qualified, but it did mean that I needed to take the extra time to strengthen my foundation moving forward. Going into my sophomore year of college, I no longer saw my knowledge gaps as incompetence, but something I could work through by going to office hours and seeking out additional resources like Khan Academy videos. Unfortunately, many students are not able to participate in programs like BRIMS and in their case, they may decide to give up on medicine just as I would have if I did not participate in the BRIMS program.
Many students who are from populations that are underrepresented in medicine (URiM) face significant barriers to becoming a physician. Whether that be a lack of foundational knowledge as in my case, low standardized test scores, lack of representative mentorship, financial barriers, imposter syndrome, and so much more. For many URiM students these challenges become prohibitive to applying to medical school, leading to a lack of diversity in the field. During my junior year of college, I decided to not only apply to medical school but also pursue a PhD because of my strong research interest.
The lack of diversity was amplified amongst the physician-scientist field. MD/PhD programs are notoriously selective and competitive. The years of research experience needed, high median MCAT, and lack of representative physician-scientist mentors with a culmination of other factors have resulted in a field that lacks diversity. In 2019, out of 579 MD/PhD graduates, 5.35% were Black, 5.17% were Hispanic, and 0 were Native Hawaiian or Other Pacific Islander (https://www.aamc.org/media/8231/download).
With such a low number of URiM students in the MD/PhD field, it is clear change needs to be made in order to strengthen the pipeline for aspiring URiM physician-scientists. This summer, I collaborated with URiM MD/PhD students at Emory, Stanford, and the University of Pennsylvania to address this very problem. We wrote a paper that discusses the challenges URiM applicants may face in the MD/PhD process and advice for overcoming these challenges. We also highlighted next steps for institutions to improve URiM recruitment, such as creating URiM-specific MD/PhD programs, implementing implicit bias trainings, and improving on the holistic review process. It was an amazing experience to unite with other URiM MD/PhD students across the country. During our Zoom meetings, we not only brainstormed ideas for effecting change, but we were also able to connect on unique challenges that arose during the application and interview process.
While there is still a lot of work to be done, I feel a sense of pride that the University of Michigan is doing such a great job in regards to improving the MD/PhD pipeline. We have a program called the UM-SMART program that is specifically for underrepresented students who are exploring the possibility of a career as a physician-scientist. After graduation, 78% of the past participants have entered MD/PhD, PhD, or MD programs. The UM-SMART program was the reason I decided to pursue an MD/PhD. It will be a long and difficult road to increase representation within the physician-scientist workforce, but I feel assured by the passion for change amongst my peers, faculty, and collaborators at other institutions.
Natalie Guzman is a first-year medical student pursuing her MD/PhD. She has gotten involved with Doctors of Tomorrow and the University of Michigan Asylum Collaborative. In her free time, she enjoys going to the Arb.